Objective To investigate the learning curve of minimally invasive direct coronary artery bypass ( MIDCAB) via left anterior small thoracotomy. Methods We retrospectively reviewed results of a consecutive series of 80 patients underwent MIDCAB via left anterior small thoracotomy performed by a single surgeon.The patients were divided into 4 groups ( group A, B, C, D, n=20 in each group) according to the sequence of the operation.The left internal mammary artery ( LIMA) harvesting time, anastomosis time, total operative time, the drainage volume of the first day postoperation, mechanical ventilation time, hospital stays postoperation, in-hospital morbidity and mortality were compared.The learning curve was assessed by means of regression analysis with logarithmic curve fitting. Results The basic clinical characters were similar in all groups before the operation.The operations were accomplished successfully in all the 80 cases.No intraoperative conversion to sternotomy, death, or perioperative myocardial infarction happened.The LIMA-harvesting time in the group B, C, and D was significantly shorter than that in the group A [(53.7 ±19.2) min, (50.2 ±17.7) min, and (43.2 ±10.3) min vs.(77.0 ±30.0) min, P =0.001, 0.000, and 0.000].There was no difference between group B and C, B and D, C and D in the LIMA-harvesting time (P>0.05).The total operative time in the group B, C, and D was significantly shorter than in the group A [ (128.7 ±21.7) min, (129.0 ±33.3) min, and (112.2 ±14.5) min vs. (165.2 ±41.8) min, all P=0.000], without difference between the group B and C, B and D, C and D (P>0.05).The learning curve models were obtained: LIMA-harvesting time ( min) =113.77 -16.869 × ln ( operation number); total operative time (min)=220.281 -25.276 ×ln (operation number). Conclusion MIDCAB via left anterior small thoracotomy is safe and effective, with a learning curve of approximately 20 cases.

Ebola virus(EBOV)and Marburg virus(MARV),belonging to the Filoviridae family,emerged four decades ago and caused severe viral hemorrhagic fever in human and other primates.As high as 50-90% mortality,filoviruses can cause significant threats to public health.However,so far no specific and efficient vaccine has been available,nor have other treatment methods proved to be effective.It is of great importance to detect these pathogens specific,rapidly and sensitively in order to control future filovirus outbreaks.Here,recent progresses in the development of detection and diagnosis methods for EBOV and MARV are summarized.

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive and lethal human cancers. Cur-rent studies on the relationship between complicated type 2 diabetes mellitus (T2DM) and PDAC prognosis have demonstrated inconsis-tent results. The present study aimed to determine the relationship between complicated T2DM and the clinicopathological characteris-tics of PDAC, and evaluate whether complicated T2DM is a significant predictor for overall survival in patients with resectable PDAC. Methods: In this study, clinicopathological characteristics were observed in 136 patients who underwent surgery for PDAC at the Shengjing Hospital of China Medical University between January 2009 and February 2011. The relationship between complicated T2DM and overall survival of PDAC patients was analyzed using univariate and multivariate analyses. Results:The median age of pa-tients was 60 years (range: 35-80 years). Among the 136 patients, 76(55.9%) were male. The prevalence of complicated T2DM was 27.9%in 136 PDAC cases. Preexisting T2DM was not associated with any of the clinicopathological characteristics (all P>0.05). Uni-variate analysis showed that complicated T2DM (P=0.045), maximum diameter (P=0.011), histological differentiation (P=0.013), pT stage (P=0.034), vessel invasion (P=0.032), and pTNM stage (P=0.030) were significantly associated with the overall survival of PDAC patients. The median overall survival time was 14.2 months for T2DM patients, and 18.8 months for non-T2DM patients. In mul-tivariate analysis, complicated T2DM [hazard ratio (HR), 1.873;95%confidence interval (CI), 1.187-2.954;P=0.007], poorly differenti-ated tumor (HR, 2.647;95%CI, 1.413-4.957;P=0.002), and maximum diameter≥4.0 cm (HR, 1.699;95%CI, 1.094-2.640;P=0.018) were the independent predictors associated with poor overall survival. Conclusion:Complicated T2DM was associated with poor prog-nosis. It could be used as a prognostic predictor in patients with resectable PDAC. If confirmed, these findings may provide a novel ap-proach for individualized adjuvant therapy.

BACKGROUND: Precise clinical treatment of talar ischemic necrosis remains controversial at present.OBJECTIVE: To observe the changes in the stress and its distribution on talar trochlear articular surface in case of talar necrosis at different levels.METHODS: The present study adopted eight ankle specimens to establish the three-dimensional finite element model of ankle. Through changes in the talar necrosis volume of these models, this study analyzed the change law of talar trochlear articular surface stress and its distribution and calculated the critical necrosis volume of traumatic foot and ankle arthritis or talar collapse that may be induced by talar ischemic necrosis.RESULTS AND CONCLUSION: The experiment successfully established the three-dimensional finite element model of ankle. This study found that talar trochlear articular surface stress distribution showed little change in case of talar medial and lateral necrosis at a lower level; when medial talar necrosis volume reached (26.6±1.5)%, and lateral talar necrosis volume reached (35.0±2.5)%. Stress concentration phenomenon occurred in the boundary area between talar necrosis tissue and normal osseous tissue, and the stress area took the shape of irregular pattern. It is suggested that surgical treatment should be considered due to the high-risk induction of ankle-foot traumatic arthritis or talar collapse.

Objective Little is known about the effects of antioxidant on the micturition function in diabetic cystopathy .In this study, we investigated the effects of antioxidant sulforaphane on bladder micturition function in diabetes mellitus ( DM)mice with bladder underactivity . Met hods We established DM models in mice by intraperitoneal injection of a single dose of streptozotocin (STZ)at 65 mg/kg and randomly divided them into three groups , sulforaphane treatment (n=10), vehicle treatment (n=10), and DM model (n=10), with another 10 normal healthy mice included as blank controls.At 24 weeks of the experiment, we obtained and analyzed such indexes of mice as the body weight , fasting blood glucose (FBG), 24-hour urine volume (24 h UV) and bladder wet weight ( BWW ) , results of cystometrography , and cystometric parameters including intercontraction interval ( ICI ) , maximum bladder pressure during micturition ( Pmax ) , maximum cystometric capacity (MCC), void volume (VV), post-void residual urine vol-ume (PVR) and residual urine rate (RUR). Results Compared with the blank controls , the DM models with bladder underactivity showed significantly increases in BWW ([67.96 ±2.35]mg), 24 h HU ([22.47 ±1.93]mL), MCC ([0.70 ±0.03]mL), VV (0[.23 ±0.01]mL), PVR ([0.49 ±0.02]mL), RUR ([70.10 ± 0.80]%), and ICI, but a remarkable decrease in Pmax .Sulforaphane treatment significantly reduced BWW ([576.9 ±2.41]mg), 24 h HU ([16.27 ±1.51] mL), MCC ([0.54 ±0.03]mL), PVR ([0.34 ±0.02]mL), RUR ([62.71 ±1.26]%), and ICI of the diabetic mice . Conclusion Sulforaphane could improve bladder micturition function in mice with STZ-induced DM , which might be related to its action mechanism of antioxidative stress damage .

Task-driven teaching method is a kind of exploration.The prospective research on the application of task-driven teaching method in social medical insurance course is helpful to setting up a teaching situation,constructing a relaxed study environment,stiring up students’interest in the study and improving students’initiatives and creativity.

Objective To determine the clinical significance of hepatocyte growth factor receptor (Met) and epidermal growth factor receptor (EGFR) in the clinicopathology and prognosis of pancreatic cancer.Methods 70 patients admitted with pancreatic cancer from 1995 to 2005 were retrospectively analyzed with clinicopathological and follow-up data.Expression of Met and EGFR in cancer nest embedded with paraffin were detected by immunohislostaining (EnVision method) and correlation with clinicopathologic parameters and mutual correlation between these two receptors were further analyzed.Prognosis and related risk factors were analyzed by Kaplan-Meier survival analysis and Cox regression analysis,respectively.Results Both Met and EGFR significantly correlated with TNM staging,tumor size and superior mesenteric vessels invasion (P＜0.05).Expression level of Met positively correlated with that of EGFR (r9 =0.658,P＜0.05).Both Met and EGFR significantly correlated with patients' survival (P＜0.05) and Met was an independent prognostic risk factor for pancreatic cancer.Conclusions Both Met and EGFR significantly affect development and prognosis of pancreatic cancer and correlate with each other.Simultaneously targeting both Met and EGFR pathways may provide an advisable strategy of targeted therapy in pancreatic cancer.

Ebola virus (EBOV) and Marburg virus (MARV) are causative agents of severe hemorrhagic fever with high mortality rates in humans and non-human primates and there is currently no licensed vaccine or therapeutics.To date,there is no specific laboratory diagnostic test in China,while there is a national need to provide differential diagnosis during outbreaks and for instituting acceptable quarantine procedures.In this study,the TaqMan RT-PCR assays targeting the nucleoprotein genes of the Zaire Ebolavirus (ZEBOV) and MARV were developed and their sensitivities and specificities were investigated.Our results indicated that the assays were able to make reliable diagnosis over a wide range of virus copies from 103 to 109,corresponding to the threshold of a standard RNA transcript.The results showed that there were about 1010 RNA copies per milliliter of virus culture supernatant,equivalent to 10,000 RNA molecules per infectious virion,suggesting the presence of many non-infectious particles.These data indicated that the TaqMan RT-PCR assays developed in this study will be suitable for future surveillance and specific diagnosis of ZEBOV and MARV in China.

Objective: To compare the blood lfow of left internal mammary artery (LIMA) graft vessel between minimally invasive direct coronary artery bypass (MIDCAB) and traditional median sternotomyin off-pump coronary artery bypass (Traditional OPCAB) by transit-time lfow meter (TTFM). Methods: We retrospectively studied 300 patients who received OPCAB in our hospital from 2013-01 to 2015-07, all patients had LIMA to left anterior descending coronary artery (LAD) anastomosis. The patients were divided into 2 groups: MIDCAB group, n=70 and Traditional OPCAB group,n=230. Intra-operative blood lfow in graft vessel was measured by transit-time lfow meter. Pre- and post-operative indexes and the mean lfow (MF), pulsatile index (PI), diastolic fraction (DF) of LIMA graft were compared between 2 groups. Results: The following indexes in Traditional OPCAB group and MIDCAB group were as below: intra-operative transfusion was (3.00±5.42) U vs (1.06±2.17) U, post-operative peak value of cTnI was (2.84±9.93) ng/ml vs (0.69±1.74) ng/ml, mechanical ventilation time was (27.9±66.9) h vs (14.2±20.8) h and ICU stay time was (64.1±89.6) h vs (35.2±39.2) h, allP<0.05; while for the graft from LIMA to LAD, MF was (29.45±18.19) ml/min vs (29.04±15.85) ml/min, PI was (2.68±1.19) vs (2.44±0.84) and DF was (71.47±11.12) % vs (70.25±11.30) %, allP>0.05. Conclusion: With LIMA to LAD graft, MIDCAB may achieve the same effect as traditional OPCAB, the early post-operative anastomosis has been reliable.

Several digital filtering techniques for correcting baseline drift from ECG signals are presented. A bidirectional filter is introduced, which can cantain baseline drift their filtering performance and realization methods are compared.
Electrocardiography ; instrumentation ; methods ; Filtration ; instrumentation ; Signal Processing, Computer-Assisted ; instrumentation